This invention relates to a medical device and method for placing surgical sutures.
In particular this invention relates to a surgical suture guide and a method for placing sutures through a cut portion of a body of an animal including a human when this portion has a tubular configuration.
In one embodiment, this invention relates to a surgical suture guide for and method of placing urethral sutures through a cut portion of a urethral meatus when the urethral meatus is surrounded by an adjacent tissue.
Radical retropubic prostatectomy is established as an effective method for the treatment of patients with localized carcinoma of the prostate gland. In the past, certain intraoperative and postoperative complications led some surgeons to favor other forms of treatment. Walsh in the publication "Radical Retropubic Prostatectomy"; Walsh PC, Gittes RF, Perlmutter AD, Stamey TA (eds); Campbell's Urology, 5th ed, Philadelphia, W B Saunders, 1986, pp 2754-2775 (which the present application incorporates by reference) provides detailed descriptions of the neurovascular anatomy of the apex of the prostate and describes an operative technique. It has been reported that based on this publication surgeons were able to reduce the incidence of complications, such as intraoperative hemorrhage, postoperative erectile impotence, and stricture formation. Walsh's technique permits the surgeon to control bleeding from the prostatic dorsal venous plexus reliably and thus to improve visualization of the apex of the prostate for controlled dissection and subsequent urethrovesical anastomosis.
However, some technical problems still remain. After division of the urethra at the apex of the prostate and removal of the prostate, the stump of the urethra retracts into the adjacent tissue, the urogenital diaphragm. Reexposure of the urethra has remained an important and frustrating task. Various solutions have been suggested. A first technique is to place sutures directly alongside a Foley catheter, which acts as a guide in identifying the lumen of the urethra. Placement of these sutures can be difficult and imprecise, and often the muscle of the urogenital diaphragm and the wall of the catheter are caught in the suture. As an added inconvenience, these sutures are usually placed inside to outside, and the needle requires rearming to complete the urethrovesical anastomosis. A second technique is to place several sutures into the cut edge of the urethra before complete division. After complete division, traction is applied to these sutures, exposing the stump away from adjacent tissue for additional suture placement. However, tension on these sutures can inadvertently lacerate the urethral stump and make further suture placement even more difficult. A third technique has been to position the patient's legs in stirrups and apply direct pressure to the perineum to push out the adjacent tissue, the urogenital diaphragm, and the urethra for direct suture placement. Another solution involves the placement of vesicoperineal pulldown sutures along with Foley catheter drainage. If all of these techniques fail, a Foley catheter can be placed into the bladder and the bladder pulled down onto the urogenital diaphragm with the hope of obtaining healing by secondary intention. These techniques are proved to be time-consuming and unreliable.